Provider Demographics
NPI:1659058980
Name:VIGIL, JADE (DDS)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:VIGIL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 CALLE DE RINCON BONITO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5639
Mailing Address - Country:US
Mailing Address - Phone:505-577-5803
Mailing Address - Fax:
Practice Address - Street 1:1439 S SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4037
Practice Address - Country:US
Practice Address - Phone:505-473-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDB-2023-01251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice